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    v1.0.31
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyNH Medicaid ORP Enrollment Update | OpenPayer
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    CurrentNew Hampshire Department of Health and Human ServicesPolicy N/A

    Mandatory Enrollment of Ordering Providers

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    Requires providers ordering services or products for New Hampshire Medicaid fee-for-service beneficiaries to be enrolled with NH Medicaid at the time of service. Applies to FFS claims requiring an order, including secondary coverage and Medicare crossover claims, but not to providers listed on managed care organization claims.

    Policy Summary
    PayerNew Hampshire Department of Health and Human Services
    PolicyMandatory Enrollment of Ordering Providers
    Policy CodePolicy N/A
    Change TypeNew enrollment requirement
    Effective DateMarch 1, 2021
    Next Review DateN/A
    Key ActionEnroll with NH Medicaid before or by the time of service when ordering services or products for NH Medicaid fee-for-service beneficiaries.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Mar 1, 2021Requirement effective date
    1 NPINPI required per applicable claim
    2 typesAdditional claim types included
    866-291-1674Provider Relations

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    NH Medicaid FFS Ordering-Provider Requirements

    NH Medicaid FFS Ordering-Provider Requirements

    For an NH Medicaid fee-for-service claim requiring an order to be covered, ALL of the following must be met:

    ALL of the following

    • The ordering provider is enrolled with NH Medicaid at the time of service.
    • The ordering provider's NPI is included on the claim when the provider is required or listed.
    • The claim is submitted under the NH Medicaid fee-for-service program.

    Ordering Provider Enrollment and Claim Submission

    Billing Rule

    Enroll as an Ordering Provider

    Before ordering services or products for NH Medicaid beneficiaries in the fee-for-service (FFS) program, enroll with NH Medicaid by the time of service. Beginning March 1, 2021, services or products requiring an order are covered by NH FFS Medicaid only when the ordering provider is enrolled.

    Billing Rule

    Report the Ordering Provider NPI

    If an ordering provider is required or listed on an NH Medicaid FFS claim, include that provider’s NPI on the claim.

    • Applies to every applicable FFS claim requiring an order.
    Denial Risk

    Use an Individual Ordering Provider

    Use an individual provider as the ordering provider. Organizational or group providers are prohibited from ordering and cannot be used as the ordering provider.

    Billing Rule

    Apply the Rule to Required FFS Claims

    Apply the ordering provider enrollment and NPI requirements to all NH Medicaid FFS claims submitted for payment that require an order.

    • Includes claims for secondary coverage.
    • Includes Medicare Crossover claims.
    Note

    MCO Claims Are Governed Separately

    Do not apply this NH Medicaid FFS ordering-provider requirement to providers listed on claims submitted to Managed Care Organizations (MCOs). MCOs may have similar requirements under their provider agreements, so follow the applicable MCO contract, enrollment, and claims-processing requirements.

    Denial Risk

    Out-of-State Enrollment Is Not Sufficient

    Enrollment in another state’s Medicaid program does not satisfy the requirement to enroll with NH Medicaid. Providers from other states who write orders or prescriptions for NH Medicaid recipients must enroll with NH Medicaid when the service requires an order.

    Note

    Use the Appropriate Enrollment Pathway

    Use the enrollment pathway that matches your provider status. Providers already enrolled as active Medicaid billing providers do not need to enroll again as ORP providers; non-billing providers seeking ORP enrollment should use NH Medicaid’s streamlined online application.

    • The shortened non-billing ORP Provider Enrollment application is available on the NH MMIS website.

    Ordering, Referring, and Prescribing Provider

    Ordering, Referring, and Prescribing (ORP) Provider
    DefinitionAn Ordering, Referring, and Prescribing (ORP) provider is a provider who orders, refers, or prescribes services or products for an NH Medicaid beneficiary and is required or listed on an applicable fee-for-service claim.
    Applicable beneficiariesNH Medicaid beneficiaries receiving services or products through the fee-for-service (FFS) program.
    Applicable claimsClaims submitted to NH Medicaid that require an order, including claims for secondary coverage and Medicare crossover claims.
    Enrollment requirementThe ORP provider must be enrolled with NH Medicaid at the time of service for the ordered services or products to be covered under NH Medicaid FFS.
    Claim identificationWhen an ORP provider is required or listed on an FFS claim, the provider's NPI must be included on the claim.
    Excluded claims
    Policy Summary
    PayerNew Hampshire Department of Health and Human Services
    PolicyMandatory Enrollment of Ordering Providers
    Policy CodePolicy N/A
    Change TypeNew enrollment requirement
    Effective DateMarch 1, 2021
    Next Review DateN/A
    Key ActionEnroll with NH Medicaid before or by the time of service when ordering services or products for NH Medicaid fee-for-service beneficiaries.
    SourceLink
    On This Page
    NH Medicaid FFS Ordering-Provider RequirementsOrdering Provider Enrollment and Claim SubmissionOrdering, Referring, and Prescribing Provider
    This FFS ordering-provider enrollment requirement does not apply to providers listed on claims submitted to managed care organizations (MCOs); MCO provider agreements and enrollment and claims-processing requirements may establish similar rules.